Effects of Pay for Performance on utilization and quality of care among Primary Health Care providers in Middle and High-Income countries

Curatio International Foundation experts reviewed Pay for Performance (P4P) effectiveness on utilization and quality of primary health care in private settings in middle-income and high- income countries.

About P4P

Pay for Performance (P4P) is a relatively new strategy aiming at improving the performance of the health care providers through incentivizing and motivating behavior change for the desired output. A number of systematic reviews have examined different angles of P4P across different economies, health system configuration, and schemes. While various reviews focus on P4P from different angles, there is no summarized evidence on how P4P works in a private environment.

Local Context

Georgia is an upper-middle-income country with a highly privatized healthcare system that has been implementing the Universal Health Care program since 2013. Despite several changes in the design, the program faces challenges: PHC services are significantly underutilized. Since the UHC introduction outpatient per capita visits per annum increased by 61% and reached 3.7 visits in 2018 in Georgia, however, it is twice lower compared to the WHO European region estimate – 7.53 visits. Moreover, PHC in Georgia has a poor gatekeeping role, it fails ineffective management of chronic diseases, in preventing a patient from using costly specialized and inpatient services and averting the health system from increased health spending/expenditure. Reimbursement mechanism and P4P specifically has been discussed as one of the policy options to address some of the challenges at the PHC level. In order to inform the policy decision on the improvements of PHC, the Health and Social Issues Committee at the Parliament of Georgia requested the CIF team to develop the evidence synthesis document.

The evidence review summarizes the existing literature on P4P effectiveness on utilization and quality of primary health care in private settings in middle-income and high- income countries. The document and its findings are especially relevant to Georgia.

The document was developed in the frame of Embedded Rapid Reviews in Health Systems Decision Making (ERA) platform in Georgia. The work was conducted with the financial support of the Alliance for Health Policy and Systems Research/WHO

Download the full document.

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